Date post: | 20-Jan-2016 |
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Richard A. Polin M.D. Professor of Pediatrics
Director of the Division of Neonatology [email protected]
S. David Rubenstein M.D. Professor of Clinical Pediatrics
THE PRETERM NEONATE
Maximus R.• Born to a 32 year old primagravida at 35 weeks• Fetal distress (bradycardia) during labor• C-section-meconium noted at membrane rupture• Apgar scores 1 and 6 ( at 1 and 5 minutes)• Persistent hypoxia despite FiO2 1.0 (pO2 >700)• IPPV initiated without significant increase in pO2• pH 7.30, pCO2 48, pO2 38, HCO3 22• Diagnosis: persistent fetal circulation
Composition of Meconium
• Sloughed intestinal epithelial cells
• Swallowed amniotic debris (hair, vernix)
• Squamous epithelial cells
• Pancreatic lipases and proteases
• Bile acids and salts
• Sucus entericus
• White blood cells
Maximus R.• Born to a 32 year old primagravida at 35 weeks• Fetal distress (bradycardia) during labor• C-section-meconium noted at membrane rupture• Apgar scores 1 and 6 ( at 1 and 5 minutes)• Persistent hypoxia despite FiO2 1.0 (pO2 >700)• IPPV initiated without significant increase in pO2• pH 7.30, pCO2 48, pO2 38, HCO3 22• Diagnosis: persistent fetal circulation
Components of the Apgar Score____________Score__________________
Sign 0 1 2
Heart rate Absent <100 >100
Respiration Absent Irregular Good cry
Color Cyanotic Acrocyanosis Pink
Tone Limp Minimal Active
Reflex Absent Minimal Active
Maximus R.• Born to a 32 year old primagravida at 35 weeks• Fetal distress (bradycardia) during labor• C-section-meconium noted at membrane rupture• Apgar scores 1 and 6 ( at 1 and 5 minutes)• Persistent hypoxia despite FiO2 1.0 (pO2 >700)• IPPV initiated without significant increase in pO2• pH 7.30, pCO2 48, pO2 38, HCO3 22• Diagnosis: persistent fetal circulation